Inflammation-Nature's Way to Efficiently Respond to All Types of Challenges: Implications for Understanding and Managing "the Epidemic" of Chronic Diseases
Inflammation-Nature's Way to Efficiently Respond to All Types of Challenges: Implications for Understanding and Managing "the Epidemic" of Chronic Diseases
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DOI：
10.3389/fmed.2018.00316
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发表时间：
2018-11-27
影响因子：
3.9
通讯作者：
Sturmberg, Joachim P.
中科院分区：
文献类型：
--
作者：
Bennett, Jeanette M.;Reeves, Glenn;Sturmberg, Joachim P.
孤立或单一系统的疾病管理方法是常见的做法，发展出传统的医学院教育。医学教科书描述了大量的离散疾病，通常以系统的方式遵循病因学，病理学，调查，鉴别诊断和管理等标题。这种方法表明，身体有多种方式来应对有害事件。然而，生理学和系统生物学提供的证据表明，这种表型变异背后有一个简单的机制。无论损伤或变化是否由创伤、感染、非传染性疾病、自身免疫性疾病或应激引起，典型的生理反应是：增加对该区域的血液供应，增加进入受影响组织的白色细胞，增加吞噬活性以去除有害物质，随后下调这些机制导致愈合。炎症级联反应是身体对宏观和微观损伤做出反应以保持其完整性的独特机制。我们假设慢性疾病的发展和进展与不受控制或功能失调的炎症损伤有关，无论其性质，身体，环境或心理。因此，我们的目标是将目前流行的个别疾病管理方法重新构建为一种更综合的系统方法，将“人作为一个整体”进行治疗，增强患者体验，进行必要改变的能力，并最大限度地提高整体健康和福祉。本文的第一部分回顾了促炎和抗炎调节的局部免疫级联反应以及与神经和心理通路相关的反馈回路。第二部分强调了自然界的工作原理之一--系统设计和效率。不断压倒这个微调系统将导致全身炎症允许慢性疾病的出现;几个常见条件的途径进行了详细描述。论文的最后部分考虑了这些理解对临床护理的影响，并探讨了这种透镜如何塑造医患接触和卫生系统的重新设计。我们的结论是，医疗保健专业人员必须倡导在患者层面以及在地方和国家层面的抗炎生活方式，以提高人口的健康和福祉。
Siloed or singular system approach to disease management is common practice, developing out of traditional medical school education. Textbooks of medicine describe a huge number of discrete diseases, usually in a systematic fashion following headings like etiology, pathology, investigations, differential diagnoses, and management. This approach suggests that the body has a multitude of ways to respond to harmful incidences. However, physiology and systems biology provide evidence that there is a simple mechanism behind this phenotypical variability. Regardless if an injury or change was caused by trauma, infection, non-communicable disease, autoimmune disorders, or stress, the typical physiological response is: an increase in blood supply to the area, an increase in white cells into the affected tissue, an increase in phagocytic activity to remove the offending agent, followed by a down-regulation of these mechanisms resulting in healing. The cascade of inflammation is the body's unique mechanism to maintain its integrity in response to macroscopic as well as microscopic injuries. We hypothesize that chronic disease development and progression are linked to uncontrolled or dysfunctional inflammation to injuries regardless of their nature, physical, environmental, or psychological. Thus, we aim to reframe the prevailing approach of management of individual diseases into a more integrated systemic approach of treating the "person as a whole," enhancing the patient experience, ability to a make necessary changes, and maximize overall health and well-being. The first part of the paper reviews the local immune cascades of pro-and anti-inflammatory regulation and the interconnected feedback loops with neural and psychological pathways. The second part emphasizes one of nature's principles at work-system design and efficiency. Continually overwhelming this finely tuned system will result in systemic inflammation allowing chronic diseases to emerge; the pathways of several common conditions are described in detail. The final part of the paper considers the implications of these understandings for clinical care and explore how this lens could shape the physician-patient encounter and health system redesign. We conclude that healthcare professionals must advocate for an anti-inflammatory lifestyle at the patient level as well as at the local and national levels to enhance population health and well-being.